Neurology Flashcards
What is myasthenia gravis?
Autoimmune neuromuscular disease characterised by muscle weakness
Age groups affected by myasthenia graves
Young females, older men
Pathophysiology of myasthenia gravis
Autoantibodies against post-synaptic acetylcholine receptors
Sx myasthenia gravis
Fatigability
Ptosis, diplopia, difficulty standing and chewing
Mx myasthenia gravis
Acetylcholinesterase - pyridostigmine
Drugs to avoid in myasthenia gravis
B Blockers
lithium
phenytoin
What is MS?
Degenerative disease of CNS caused by inflammation and demyelination
Sx MS
Visual - optic neuritis Sensory - paraesthesia and trigeminal neuralgia Motor - spastic weakness Cerebellar - ataxia and tremor Urinary incontinence and fatigue
Dx MS
MRI brain - sclerotic plaques
Mx MS
B-interferons
What is Huntington’s
Autosomal dominant condition caused by repeats of CAG
Sx Huntington’s
Cognitive - dementia, behavioural changes
Chorea, dystonia, dysarthria
Tx chorea
Tetrabenazine and benzodiazepines
Tx bradykinesia
Levodopa
Tx depression
SSRI
What is Parkinson’s disease?
Neurodegeneration of dopamine neurones in substantia nigra
Sx Parkinson’s
Bradykinesia
Tremor at rest
Rigidity
Depression
Mx Parkinson’s
Levodopa
Torticollis
Systained muscular contraction of neck
Akathisia
Restlessness
Febrile convulsions
Children 6m-5y, occur due to viral infection, brief and tonic-clonic in nature
Alcohol withdrawal seizures
Decreased inhibitory GABA and increased NMDA glutamate due to cessation of drinking, normally 36h after
Non-epileptic seizures
No characteristic electrical discharges
Focal seizures
Start in a specific area of the brain
Generalised seizures
Both sides of brain, lose consciousness, lots of sub-types like tonic-clonic and typical absence
Infantile spasms
Flexion of head, trunk and limbs, last 1-2 seconds, mental handicap, due to neurological abnormality
Simple partial seizures
Focal and aware
Complex partial seizures
Focal and impaired
Temporal seizure sx
Hallucinations and automatisms
Frontal lobe seizure sx
Motor - head/leg movements
Parietal lobe seizure sx
Paraesthesia (sensory)
Occipital lobe seizure sx
Floaters/flashes
first line treatment for generalised seizures
sodium valproate
second line treatment for generalised seizures
lamotrigine
first line treatment for focal seizures
carbamazepine
second line treatment for focal seizures
sodium valproate
what is a hypnagogic jerk
just as you are about to fall asleep
what should you do if seizure lasts more than 10 mins
benzodiazepine - diazepam under tongue
Acute closed angle glaucoma sx
- Severe pain - ocular or headache
- Decreased visual acuity
- Sx worse with mydriasis
- Hard/red eye
- Non-reacting pupil
- Systemic upset - nausea/vomiting/abdo pain
treatment of acute closed angle glaucoma
- Parasympathomimetic - pilocarpine - increases outflow
- B-blocker - propanolol - decreases humour production
Alzheimer’s pathophys
Mutations in amyloid precursor proetin (chr21), presenilin 1 (chr14) and presenilin 2 (chr1) are risk factors
Macroscopic changes:
- Cerebral atrophy - cortex and hippocampus
Microscopic changes:
- AB plaques and tau tangles
medical treatment Alzheimer’s
Acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) for mild-moderate
Where is the lesion in wernicke’s aphasia?
Superior temporal gyrus - supplied by inferior MCA
sx wernicke’s
pt has fluent speech but no meaning - comprehension is impaired
Where is the lesion in Broca’s aphasia
Lesion in inferior frontal gyrus (supplied by superior left MCA)
sx Broca’s aphasia
normal comprehension but can’t speak
conduction aphasia
speech is fluent but repetition is poor, comprehension is normal
area of brain affected by conduction aphasia
arcuate fasiculus
global aphasia
severe expressive and receptive aphasia
what is arnold-chiari malformation
Downward displacement/herniation of cerebellar tonsils through foramen magnum
Sx Bell’s palsy
- LMN facial nerve palsy - forehead affected
- Post-auricular pain
- anterior 2/3 tongue (cn7)
which CN is affected in Bell’s palsy
7
tx Bell’s palsy
- Prednisolone within 72h
- Refer to ENT if 3 weeks with no improvement
erb’s palsy
- Damage to C5-6 roots
- Winged scapula
- May be caused by breech presentatio
klumpke’s palsy
- Damage to T1
- Loss of intrinsic hand muscles
- Forearm supinated, wrist and fingers flexed
are brain lesions contralateral or ipsilateral
contralateral
parietal lobe lesion
sensation changes, inferior homonymous quadrantopia
occipital lobe lesion
homonymous hemianopia, cortical blindness